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Humana Expands Bundled Payment Model for Medicare Advantage

The health insurance company is expanding a bundled payment model for hip and knee replacements for Medicare Advantage members.

Humana expands bundled payment model for Medicare Advantage

Source: Thinkstock

By Thomas Beaton

- Humana has expanded a bundled payment model into seven additional states that will cover hip and knee replacements within Medicare Advantage populations.

The payer has teamed up with orthopedic specialists to expand its Total Joint Replacement Episode-Based Model into Alabama, Florida, Georgia, Illinois, Louisiana, Mississippi, and Texas. Humana plans to expand the model into provider groups located in Indiana, Tennessee, and Virginia.

Humana’s hip-and-knee replacement model is designed to improve beneficiary care outcomes during an entire episode of care while reducing costs. The model incorporates datasets to evaluate and improve care from the start of a patient’s diagnosis to her recovery.

The bundled payment program aims to ultimately reduce hospital readmissions and treatment complications by improving care coordination in a provider organization.

Humana’s new payment model, as well as other value-based care programs, relies on preventive screenings, personalized provider experiences, data analytics, and value-based reimbursement to create cost-effective healthcare experiences.

Humana originally implemented the bundled payment model in 2016 within Ohio and Tennessee. The payer’s new expansion offers the model within a total of 40 provider locations within 13 states.

Leaders at Humana believe that the new payment model can effectively build on its value-based initiatives within Medicare Advantage beneficiary populations.

Currently, Humana has 66 percent of its Medicare Advantage membership (2.9 million beneficiaries) visiting providers that participate in value-based care models.

“We’re excited to accelerate this innovative value-based care model into additional markets, significantly growing the reach of a program specifically tailored for orthopedics,” said Humana Provider Development Center of Excellence Vice President Caraline Coats.  

“Humana is dedicated to building relationships with physicians and providing the support they need as we work together to create a more seamless, patient-centered experience and help members achieve their best health.”


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